Clinical Neuroscience

[Data on female alcoholism]

BÖSZÖRMÉNYI Zoltán1, SRÁGLI Gyula1

OCTOBER 01, 1960

Clinical Neuroscience - 1960;13(10)

[The Communication looks at the increasing prevalence of alcoholism among women worldwide, according to statistical data ; it presents the main data available to explain this phenomenon. The authors have derived their own findings from a comparative study of the histories of 303 female patients discharged from the National Institute of Neurology and Mental Health between 1 January 1954 and 31 December 1959, and of 150 male alcoholics from the same period, used as a control. They found a smaller increase in the number of female alcoholics, and that the majority of women are withdrawn much earlier than men, with a higher incidence of alcoholism in their families. The majority of women drinkers are only engaged in domestic or other simple-primitive work. Only 15.3% of women and 42% of men were considered to be normal drinkers, with the latter making much less effort to explain their drinking. Women are more withdrawn in group psychotherapy sessions, but seem to need this treatment more than men. The authors present three illustrative case reports. They conclude that the rise in the number of women alcoholics should not be accepted as a necessary consequence of the neutralisation process (Bürger-Prinz), but should be combated by adequate education.]

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  1. Országos Ideg-és Elmegyógyintézet

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Clinical Neuroscience

[Experimental eosinophil number changes in response to a new iminodibenzyl derivative]

ANTAL János

[We investigated the effect of a new iminodibenzyl derivative, Tofranil, on the eosinophil count in circulating blood and the eosinopenia reactivity. We found that at a dose of 0.1-0.5 mg/100 g, the eosinophil cell count almost doubled after a weekly daily dose. At higher doses (1-5 mg/100 g), a single injection can maintain high eosinophil levels after one week. Also at a high dose (1-5 mg/100 g), eosinophilia develops as early as 4 hours after injection. Thyroidectomy abolishes the eosinophilic effect of Tofranil acut. High dose given once daily (1--5 mg/100 g) or low dose given daily for a week (0.1-0.5 mg/100 g) prevents eosinophilic reaction to 50 pg epinephrine administration 4 hours after onset. Inhibition of eosinopenia was only minor when administered as a single small dose or when Tofranil was given one hour before epinephrine. It is assumed that Tofranil induces complex neuroendocrinological effects in rats.]

Clinical Neuroscience

[Intracranial metastasis]

GOMBI Róza, HULLAY József

[The authors report clinical, surgical and pathological evaluation of 35 operated brain metastases. In their material, metastasis represented 9% of brain tumour cases. Postoperative mortality was 17%. Postoperatively, the mean survival of patients was 8 months and the overall survival was 51%. Based on the surgical and pathological picture, a percutaneous tumor cell embolus metastasis mechanism is considered likely and suggests that cortico-subcortical cancer metastases removed by radical resection do not recur locally. Most of these cases were cancer metastases. In their dissected cases, multiple brain metastases were always found. In terms of localisation, frontal metastases (42%) and primary tumours located in the lung (42%) were the most common. Regarding the question of surgical indications, it is pointed out that the principle that only solitary metastases should be operated on is not feasible in practice, due to current diagnostic capabilities and for reasons that, apart from absolute infaust cases, argue in favour of surgery in cases of multiple metastases. ]

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We aimed to investigate the association between fluoxetine use and the survival of hospitalised coronavirus disease (COVID-19) pneumonia patients. This retrospective case-control study used data extracted from the medical records of adult patients hospitalised with moderate or severe COVID-19 pneumonia at the Uzsoki Teaching Hospital of the Semmelweis University in Budapest, Hungary between 17 March and 22 April 2021. As a part of standard medical treatment, patients received anti-COVID-19 therapies as favipiravir, remdesivir, baricitinib or a combination of these drugs; and 110 of them received 20 mg fluoxetine capsules once daily as an adjuvant medication. Multivariable logistic regression was used to evaluate the association between fluoxetine use and mortality. For excluding a fluoxetine-selection bias potentially influencing our results, we compared baseline prognostic markers in the two groups treated versus not treated with fluoxetine. Out of the 269 participants, 205 (76.2%) survived and 64 (23.8%) died between days 2 and 28 after hospitalisation. Greater age (OR [95% CI] 1.08 [1.05–1.11], p<0.001), radiographic severity based on chest X-ray (OR [95% CI] 2.03 [1.27–3.25], p=0.003) and higher score of shortened National Early Warning Score (sNEWS) (OR [95% CI] 1.20 [1.01-1.43], p=0.04) were associated with higher mortality. Fluoxetine use was associated with an important (70%) decrease of mortality (OR [95% CI] 0.33 [0.16–0.68], p=0.002) compared to the non-fluoxetine group. Age, gender, LDH, CRP, and D-dimer levels, sNEWS, Chest X-ray score did not show statistical difference between the fluoxetine and non-fluoxetine groups supporting the reliability of our finding. Provisional to confirmation in randomised controlled studies, fluoxetine may be a potent treatment increasing the survival for COVID-19 pneumonia.

Clinical Neuroscience

Late simultaneous carcinomatous meningitis, temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting with mono-symptomatic vertigo – a clinico-pathological case reporT

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Although vertigo is one of the most common complaints, intracranial malignant tumors rarely cause sudden asymmetry between the tone of the vestibular peripheries masquerading as a peripheral-like disorder. Here we report a case of simultaneous temporal bone infiltrating macro-metastasis and disseminated multi-organ micro-metastases presenting as acute unilateral vestibular syndrome, due to the reawakening of a primary gastric signet ring cell carcinoma. Purpose – Our objective was to identify those pathophysiological steps that may explain the complex process of tumor reawakening, dissemination. The possible causes of vestibular asymmetry were also traced. A 56-year-old male patient’s interdisciplinary medical data had been retrospectively analyzed. Original clinical and pathological results have been collected and thoroughly reevaluated, then new histological staining and immunohistochemistry methods have been added to the diagnostic pool. During the autopsy the cerebrum and cerebellum was edematous. The apex of the left petrous bone was infiltrated and destructed by a tumor mass of 2x2 cm in size. Histological reexamination of the original gastric resection specimen slides revealed focal submucosal tumorous infiltration with a vascular invasion. By immunohistochemistry mainly single infiltrating tumor cells were observed with Cytokeratin 7 and Vimentin positivity and partial loss of E-cadherin staining. The subsequent histological examination of necropsy tissue specimens confirmed the disseminated, multi-organ microscopic tumorous invasion. Discussion – It has been recently reported that the expression of Vimentin and the loss of E-cadherin is significantly associated with advanced stage, lymph node metastasis, vascular and neural invasion and undifferentiated type with p<0.05 significance. As our patient was middle aged and had no immune-deficiency, the promoting factor of the reawakening of the primary GC malignant disease after a 9-year-long period of dormancy remained undiscovered. The organ-specific tropism explained by the “seed and soil” theory was unexpected, due to rare occurrence of gastric cancer to metastasize in the meninges given that only a minority of these cells would be capable of crossing the blood brain barrier. Patients with past malignancies and new onset of neurological symptoms should alert the physician to central nervous system involvement, and the appropriate, targeted diagnostic and therapeutic work-up should be established immediately. Targeted staining with specific antibodies is recommended. Recent studies on cell lines indicate that metformin strongly inhibits epithelial-mesenchymal transition of gastric cancer cells. Therefore, further studies need to be performed on cases positive for epithelial-mesenchymal transition.

Clinical Neuroscience

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Clinical Neuroscience

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Clinical Neuroscience

[What happens to vertiginous population after emission from the Emergency Department?]

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[Background – Dizziness is one of the most frequent complaints when a patient is searching for medical care and resolution. This can be a problematic presentation in the emergency department, both from a diagnostic and a management standpoint. Purpose – The aim of our study is to clarify what happens to patients after leaving the emergency department. Methods – 879 patients were examined at the Semmel­weis University Emergency Department with vertigo and dizziness. We sent a questionnaire to these patients and we had 308 completed papers back (110 male, 198 female patients, mean age 61.8 ± 12.31 SD), which we further analyzed. Results – Based on the emergency department diagnosis we had the following results: central vestibular lesion (n = 71), dizziness or giddiness (n = 64) and BPPV (n = 51) were among the most frequent diagnosis. Clarification of the final post-examination diagnosis took several days (28.8%), and weeks (24.2%). It was also noticed that 24.02% of this population never received a proper diagnosis. Among the population only 80 patients (25.8%) got proper diagnosis of their complaints, which was supported by qualitative statistical analysis (Cohen Kappa test) result (κ = 0.560). Discussion – The correlation between our emergency department diagnosis and final diagnosis given to patients is low, a phenomenon that is also observable in other countries. Therefore, patient follow-up is an important issue, including the importance of neurotology and possibly neurological examination. Conclusion – Emergency diagnosis of vertigo is a great challenge, but despite of difficulties the targeted and quick case history and exact examination can evaluate the central or peripheral cause of the balance disorder. Therefore, to prevent declination of the quality of life the importance of further investigation is high.]